PRISMA model for improving maternal-child healthcare outcomes in Rivers State, Nigeria
Using the PRISMA model, the research aims to improve maternal healthcare (MH) in Rivers State, Nigeria. The need to address the problem is due to the high rate of deaths in the region. The problem stems from complex clinical and non-clinical factors such as cultural and religious practices, accessibility, acceptability and affordability issues, poor healthcare management practices, weak infrastructures and a low level of education. The interrelations and complexity between factors make it extremely difficult to ascertain the most significant impacts on MH outcomes. The consequence of this is that the intervening strategies deployed to manage MH problems in Nigeria struggle to match the actual causes of the problem. Hence, PRISMA is adopted in this study to support the risk management and mitigation process.
The PRISMA provided a holistic and evidence-based approach for addressing the complexities of factors associated with the system. It investigated the root causes of mortality in four distinct categories: technical, organisational, human-behaviour, and patient-related factors. In an explanatory sequential mixed method design, first, a PRISMA-based questionnaire (PRMQ) was administered to clinicians, and the data were analysed using the exploratory factor analysis to investigate the significant factors contributing to poor outcomes in participating hospitals.
The quantitative study revealed two distinct categories of failures in their order of riskiness. The first category was mainly internal issues resulting from inadequate patient safety culture and practices, lack of clinical equipment and necessary infrastructure, leading to unsuccessful obstetrics interventions and failures associated with organisational, technical and human-behaviour factors. The second category was the patient-related factors such as medical conditions, poverty, illiteracy, traditional medicines, and women self-medicating. Based on the factor analysis result, the first category ranked highest in the order of riskiness. A further examination of the risk categories suggests that the first category of failures was preventable and patient factors were unpreventable in most cases, which is consistent with findings from previous studies. However, since the factor analysis revealed that the most significant factors were internal failures, the research stresses the need first to manage preventable issues as it positions the organisation strategically to manage unpreventable patient-related issues.
Following the quantitative study, a complementary semi-structured interview was conducted with 12 health experts, which provided more insight into failures in the system. The interview was manually transcribed and thematically coded into the PRISMA categories of risks, which provided holistic recommendations for improving MH in Rivers State. The recommendation includes internal and external actions for addressing the problem and, therefore, has implications for policies and clinical practice. Internal actions needed to improve MH in Rivers State are strategic human resource management, management oversight, regular internal audit, standard operating procedures, and information communication technology to coordinate clinical practices. Externally, the government is responsible for providing necessary infrastructure, healthcare funding, strengthening the insurance system, and instigating policies favourable to MH. The research recommends collaborations with diverse groups such as the traditional birth attendants, non-government organisations, community and spiritual leaders, educationalists, private investors and external regulatory bodies to strengthen healthcare practices. The healthcare providers' key role is to provide effective leadership, facilitate these relationships, and engage with multiple stakeholders.
Therefore, the study addressed the three research problems: lack of risk management and evidence-based practices in low-resource healthcare settings. Secondly, there is a lack of an integrated and holistic approach to improving MH delivery in Nigeria. Thirdly, intervention
employed in Nigeria to improve MH outcomes fails to progress into responsive actions involving multiple stakeholders
Theoretically, the PRISMA model is modified to include socio-economic factors, direct and indirect medical factors contributing to failures in the system, including factors relating to gross misconduct within the organisation as the research findings reveal implications of these factors in the Nigerian context. Also, the PRMQ designed by the researcher is a clinical tool that can support risk investigation and management. The research adds a new perspective to risk management in low-income countries and provides valuable insight into MH organisational governance literature.
- School of Management